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Efficacy of Rhodamine Light in the Treatment of Superficial Vascular Lesions of the Face

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Original Paper

Med Princ Pract 2016;25:477–482 DOI: 10.1159/000446987

Efficacy of Rhodamine Light in the

Treatment of Superficial Vascular

Lesions of the Face

Piero Campolmi

 

a

Giovanni Cannarozzo

 

a

Federica Dragoni

 

b

Rossana Conti

 

b

Silvia Moretti

 

b

 

a

  Centro Salus, and b   Section of Dermatology, Department of Surgery and Translational Medicine, University of

Florence, Florence, Italy

Introduction

Vascular lesions of the face represent an aesthetic problem and are a symptom of different skin diseases [1] . Currently, laser technology can be considered an effective treatment modality for superficial vascular lesions of the face using light sources with visible (500–800 nm) and near-infrared (800–1,300 nm) wavelengths [2] . Initially, the most widely used systems to treat these lesions were potassium titanyl phosphate (KTP, 532 nm), the copper vapor laser (511/578 nm), the alexandrite laser (755 nm) and the diode laser (800/810/930 nm). The current sys-tems such as the dye laser (595 nm), Nd:Yag laser (1,064 nm) and pulsed-light system (500–1,200 nm) were then introduced [3] .

The choice of an effective laser for treating vascular le-sions should take into account the wavelength at which the vascular chromophore has the greatest absorption; these devices focus on oxyhemoglobin which has 3 wave-length absorption peaks, i.e. at 418, 542 and 577 nm ( fig. 1 ) [4] .

Rhodamine intense pulsed light (r-IPL) is a new pulsed-light system optimized for wavelengths ranging between 550 and 650 nm, which can achieve performanc-es comparable to those of the dye laser (595 nm). The r-IPL handpiece uses rhodamine as a fluorescent substance Key Words

Telangiectasias · Laser · Pulsed light

Abstract

Objective: The aim of this work was to verify the usefulness and efficacy of treating superficial vascular lesions of the face using rhodamine intense pulsed light (r-IPL). Subjects and

Methods: Fifty patients suffering from telangiectasias of the

face were enrolled and subsequently treated 4 times (every 20 days) with a new intensified r-IPL system optimized at the same wavelength as the dye laser (595 nm). The outcome was assessed using photographs, and clinical evaluations were made based on the percentage of fading of the ery-thema and telangiectasias in the lesions after treatment.

Re-sults: Marked clinical improvements (70–100%) were

ob-served in 31 (62%) patients after the second session of r-IPL, while 46 (92%) showed a marked improvement after the fourth session. No patients had to resort to topical or sys-temic drugs. Conclusion: r-IPL was effective in treating su-perficial vascular lesions, no side effects were observed and the patients readily accepted the treatment. Hence, r-IPL could be promising for the treatment of superficial vascular lesions of the face. Future study would be necessary to con-firm the long-term efficacy of this technique.

© 2016 S. Karger AG, Basel

Received: August 12, 2015 Accepted: May 22, 2016 Published online: May 23, 2016

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that can absorb wavelengths in the UV spectrum up to 550 nm and re-emit these in fluorescence in a range of between 550 and 650 nm, with a rhodamine peak at ap-proximately 570 nm, without losing energy during the transformation ( fig. 2 ). This system of shifting the emis-sion band via fluorescence can also exploit the compo-nent closest to the UV spectrum (between 450 and 500 nm) not selected for vascular lesions. This range of wave-lengths would not produce therapeutic effects and cause interactions in the pigmentary component only, so it is usually eliminated in traditional pulsed-light systems through the use of filters. The r-IPL technology does not eliminate a significant amount of energy, but rather trans-fers it to a vascular frequency range, as for dye laser spec-ifications, in order to increase both energy efficiency and performance on the hemoglobin chromophore ( fig. 3 ).

The use of waveguides, which transfer the energy that is generated, and subsequently optimized, into the tissue, allows the handpiece to be moved away from the skin to increase treatment area visibility. The handpiece can be adapted to effectively reach every area of the face includ-ing those hardest to access, such as the base of the nose. As in other laser systems, optimized cooling of the wave-guide protects the epidermis against pulsed-light radia-tion, thereby maintaining the integrity of the surround-ing tissue. Coolsurround-ing is also used to generate a local anes-thetic effect over the radiated area, making the treatment more comfortable. The aim of this study was to verify the usefulness and effectiveness of r-IPL and to demonstrate if it can indeed merge the advantages of IPL and laser de-vices in treating superficial vascular lesions of the face.

Subjects and Methods

A total of 50 patients (29 females and 21 males, aged between 30 and 60 years), of skin phototypes I–IV and suffering from tel-angiectasias of the face, were examined and subsequently treated in our university-based Dermatology Outpatient Clinic from Oc-tober 2013 to November 2014. Patients were suffering from com-mon telangiectasias (n = 23), facial erythrosis (n = 11), acne rosacea (n = 7) or telangiectasias of the nose (n = 5) and chin (n = 4). The study was carried out according to the principles of the Declaration of Helsinki and was approved by the Institutional Review Board. Written informed consent was obtained from each patient for the treatment and release of photographic images for scientific pur-poses.

400 450 500 550 600 650 700 750 800 Wavelength (nm) Oxyhemoglobin Deoxyhemoglobin Dye laser range Melanin

Fig. 1. Absorption spectrum of the main skin chromophores and hemoglobin selectivity of the dye laser.

450 500 550 600 650 700 750 800 Wavelength (nm) IPL without rhodamine light IPL with rhodamine light Dye laser range

Fig. 2. Emission frequencies of IPL, rhodamine light and dye laser.

Color version available online Color version available online

400 450 500 550 600 650 700 750 800 Wavelength (nm) Oxyhemoglobin r-IPL

Dye laser range

Fig. 3. Increase in vascular performance of r-IPL on the hemoglo-bin cromophore.

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The study treatment protocol involved the use of a new system, a rhodamine light handpiece (DEKA M.E.L.A srl, Florence, Italy), which exploits rhodamine as a selective fluorescent substance for the vascular target. Two handpieces were available with an

emis-sion area of 2 and 6.2 cm 2 , respectively, and supplied with an

in-tegrated cooling system. All the patients were subjected to an ef-fectiveness check during the first visit (October 2013 to August 2014) and subsequently treated every 20 days for a total of 4 treat-ments. The protocol provided fluencies ranging between 18 and

23 J/cm 2 , with an emission area of 2 or 6.2 cm 2 , selected according

to the severity and size of the lesions. We usually started with a

low fluency of 18 J/cm 2 , which was gradually increased in

subse-quent sessions to up to 23 J/cm 2 . Two pulses of 6–8 ms each were

performed with a delay of 10 ms between pulses. Conductive cold gel for pulsed light was placed between the crystal and the light to provide optimal contact and heat dispersion. Not much pressure was exerted during treatment so as to avoid causing any vessel ischemia. Patients were photographed before the first treatment and at the end of the therapy with a digital camera system, Anthol-ogy (DEKA M.E.L.A. srl), and with Antera 3D (Miravex Ltd., Dublin, Ireland), a noninvasive photographic device that uses a multisource spectrum and 3-dimensional mapping of the skin surface and is able to analyze both the hemoglobin and melanin skin components. It was thus possible to estimate the length and width of the capillaries, the area of the lesion and the concentra-tion of hemoglobin with the Antera system. The most extensively vascularized areas showed in the pictures in colors ranging from red to purple. All images were evaluated on 2 databases (Anthol-ogy and Antera 3D) in order to verify the efficacy of r-IPL on the vascular pattern.

The outcomes were evaluated from photographs taken by in-dependent clinical observers (G.C. and R.C.), i.e. not the operator dermatologist. Based on the percentage of fading of the erythema and telangiectasias in the lesions after treatment, they were divided into 4 categories: no outcomes (0%), a slight improvement (1– 40%), a moderate improvement (40–70%) and a marked improve-ment (70–100%).

Both during and after therapy, the patients were asked to quan-tify the perceived pain as mild, moderate or severe. A clinical eval-uation of transient erythema and posttreatment edema was carried out by a dermatologist (R.C.) and identified as absent, mild or in-tense.

Results

The mean age of the 50 patients was 44.6 + 15.3 years. A marked clinical improvement was observed in 31 (62%) of the 50 lesions after the second session of r-IPL, and 46 (92%) showed a marked improvement after the fourth session ( fig. 4 ; table 1 ). The outcomes are highlighted in figures 5–8 , where clinical pictures taken before and after the treatment are compared with the images obtained with the Antera system.

All the patients tolerated the treatment well, 78% re-ported mild pain and 22% rere-ported moderate pain that lasted a few minutes during and after the treatment. No

patients underwent systemic antibiotic or corticosteroid therapy and there were no side effects.

In the immediate posttreatment period, slight tran-sient erythema and edema were reported, which were treated with simple soothing creams.

Discussion

The treatment of facial telangiectasias is ever more fre-quently performed by laser or IPL devices. In this study, we demonstrate the efficacy and the safety of r-IPL for treating superficial vascular lesions of the face, combining the advantages of dye laser and IPL.

Dye laser is the mainstay of treatment of vascular le-sions such as facial telangiectasias because of its high de-gree of safety and efficacy [5–8] . Despite its excellent re-sults, the appearance of clear, purple bruises and subse-quent scabbing in the posttreatment period that continue

Second session No results Slight improvement Moderate improvement Marked improvement Fourth session 0 10 20 30 40 50 60 70 80 90 100%

Fig. 4. Overall improvement assessment.

Table 1. Marked improvement at the fourth session

Disorder Patients showing a

marked improvement at the fourth session, n (%)

Common telangiectasia 23 (100)

Facial erythrosis 10 (90.9)

Acne rosacea 6 (85.7)

Telangiectasia of the nose 4 (80)

Telangiectasia of the chin 3 (75)

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for several days could significantly limit its acceptance by patients who are treated for an aesthetic disease like tel-angiectatic rosacea. Conversely, according to our experi-ence, treatment with r-IPL is not followed by the appear-ance of long-lasting purpura but only by transient ery-thema and edema which did not limit the patients’ daily activities.

Several studies have demonstrated that IPL is another effective alternative or complementary therapeutic pre-sidium to vascular laser [9–12] . IPL emits a polychromat-ic noncoherent broad-band light (500–1,200 nm). Its

emission can, however, be made more selective by using proper filters and directing it towards specific chromo-phores such as melanin and hemoglobin [13] . The advan-tages of this technology are that it can hit the vascular target localized at different depths and with different wavelengths. Conversely, the most significant limitation of IPL is that more energy is released within the infrared spectrum, leaving little energy in the visible spectrum where the maximum peaks for hemoglobin absorptions are located, as is achieved with the dye laser [14] . Accord-ing to our experience, r-IPL has proven to enhance

per-a b

Fig. 5. Clinical images of a patient with

facial telangiectasia. a Before treatment.

b After 4 treatments with r-IPL, there was

a marked improvement.

a b

c d

Fig. 6. Marked improvement in a patient with severe telangiectasia and erythrosis of the face. Before treatment: clinical image

( a ) and image obtained with Antera ( b ).

After 4 treatments with r-IPL, the clinical

image ( c ) and images obtained with Antera

( d ) show a marked improvement.

Color version available online

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a b

c d

a b

c d

Fig. 7. Patient with erythrosis and fine tel-angiectasia of the cheeks. Before treatment:

clinical image ( a ) and image obtained with

Antera ( b ). After 4 treatments with r-IPL,

the clinical image ( c ) and images obtained

with Antera ( d ) show a marked

improve-ment.

Fig. 8. Another patient with telangiectasia of the cheeks. Before treatment: clinical

im-age ( a ) and image obtained with Antera

( b ). After 4 treatments with r-IPL, the

clin-ical image ( c ) and image obtained with

An-tera ( d ) show a marked improvement.

Color version available online

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formance in the working range of dye laser systems, thereby allowing greater outputs of energy at vascular wavelengths with no side effects.

In our study, marked improvements were observed in the majority of patients after the second session and in almost all of the patients after the fourth session. After the treatments, patients did not have to resort to topical or systemic drugs, so all of them showed excellent compli-ance during all 4 treatments established according to the protocol.

Thus, conversely to the other laser or light therapies, rhodamine light did not result in any side effects and pa-tients readily accepted the treatment.

A limitation of this study was the absence of a long-term monitoring of the patients that would have demon-strated the efficacy of this technique over a long period.

Conclusion

Our study showed that r-IPL did not have any report-ed side effects and also had an excellent outcome in all patients. These benefits could make this form of IPL promising for the treatment of superficial vascular lesions of the face. The absence of intense erythema and scabs al-lows us to suggest that higher fluencies may be used in order to obtain the same results in a smaller number of treatments. This aspect will need to be verified in future studies.

Disclosure Statement

There were no conflicts of interest.

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